PEPconnect

ARTIS pheno System Operation

This training module will introduce you to the workflows when operating the ARTIS pheno.

Welcome to the ARTIS pheno System Operation online training. This training will introduce you to the workflows required for operating the system. In particular, you will learn about: Patient registration Positioning the patient Selecting protocols and adjusting parameters Moving the system to working position Performing routine acquisitions   Upon successful completion of this course, you will be able to:   Perform system start-up and understand the start-up modes Register the patient using automatic and manual methods Move the system to working position using programmed positions Perform routine acquisitions Store and review images Congratulations. You have completed the ARTIS pheno System Operation online training course. Listed below are the key points that have been presented.  Take time to review the material before you proceed to the final quiz. Download and print a copy of the Course Review. System Start-up: You press the Power-on button on the Central Power Control (CPC) for 0.5 seconds to start the system During start-up all system components are started at the same time, each component requires a different amount of time to complete start-up. The system has different Operation modes providing access to functions as they are available: In BYPASS mode fluoroscopy is available.  In Backup mode fluoroscopy and acquisitions are available.  In Full operation all system functions are available.  In BYPASS and Backup mode the software is still initializing and it will not be possible to register a patient, post-process images or store images.   Home screen: When system start-up is complete the Home screen appears in the Control room. The Home Screen provides direct access to the tasks: Patient registration Searching for patients Importing patient data Additionally, you will find access to the Online Help, Configuration Panel and shutting down the system.   Welcome screen: After system start-up is complete, the Welcome screen appears on the Large Display in the exam room displaying the patient name, the registered position and the exam set selected.   Patient Registration: The patient can be registered using one of the following methods: Registration via the Radiology Information System (RIS) Automatic registration after the patient is registered on Sensis. Manual registration. Emergency patient registration. When the patient is registered by Emergency patient registration, the information can be corrected via the Edit/correct icon on the patient browser. Patient information from the RIS cannot be corrected.   Transferring and positioning the Patient: There is a pre-programmed Patient Transfer position available on the touchscreen on the C-arm Position menu > Patient Transfer. When transferring the patient, system movements and radiation should be blocked. To block movements and radiation, select the keys on the Pilot control module.   Move the system to working position: Pre-programmed system positions are available from the C-Arm Positions menu on the touchscreen. There are different types of pre-programmed system positions available: System Positions: Basic positions, for example, head side, left side, right side. Anatomical Positions: Positions to create a specific image view, LAO/RAO, Cranial/Caudal. Direct Positions: Easy access positions that can be stored easily during the case. Direct positions can be accessed anytime by swiping right to left on the touchscreen. Current Positions: Adjusts the C-arm to a position demonstrated in the reference and 3D images. To move to programmed positions, select the position from the C-Arm Positions menu on the touchscreen and press Hold to Drive on the touchscreen. You can also move to programmed positions by pressing down on the joystick and deflecting the joystick away from you or if configured, pressing the Hands-free pedal on the footswitch. You can store your own Anatomical Positions on the touchscreen and organize the stored positions on the system console: Options > Configuration Panel > Organize Stored positions. Isocenter: The isocenter is the center of rotation. By placing the organ of interest in the isocenter, you ensure that the organ remains in within the field of view during C-arm angulations, limiting the need to change the table height throughout the examination. To set the isocenter, you align the region of interest in the frontal plane and you adjust the working height so that the region of interest is centrally located between the image receptor and the focal spot of the tube. The most accurate way to determine the isocenter is to perform fluoroscopy in the frontal and lateral planes to confirm that the region of interest is centrally located on the image. Once the isocenter has been defined, you set the isocenter on the touchscreen: Table > Define as ROI. If the table height is changed, you can return to the isocenter height on the touchscreen: Table > Move table to isocenter.   Exam set, fluoroscopy and acquisition protocol:   Acquisition, fluoroscopy and roadmap protocols are arranged in Exam sets that are adapted for the specific body region and examination type. An Exam set is comprised of: A number of acquisition protocols (with the possibility of one alternative acquisition protocol) Three fluoroscopy protocols known collectively as a fluoro triplet Possibly three assigned roadmap protocols The exam sets and protocols can be selected in the control room on the system console in the Examination task card  and in the exam room on the touchscreen on the Examination menu.   Adjusting fluoroscopy/roadmap and acquisition parameters: You can adjust fluoroscopy/roadmap and acquisition parameters in the Exam and Control room. You adjust parameters on the touchscreen in the exam room and on the Examination task card on the system console in the control room. It is possible to change the fluoroscopy/roadmap protocol, the acquisition protocol, plus the following parameters: Fluoroscopy pulse rate Acquisition frame rate Measuring field Scene length   Acquisition modes: Images are acquired in different Acquisition modes. Images may be acquired in 2D, 3D, native or subtracted display or you may require another special type of acquisition mode, for example Peristepping.  DR: Digital radiography (DR) is the name given to images acquired digitally without subtraction. CARD: The standard images acquired in Cardio-angiography are 2D and displayed native (without subtraction). DSA: Digital subtraction angiography (DSA) is a special mode of acquisition to demonstrate vessels. A subtraction is performed between the mask and the fill images to result in a 2D subtracted image, demonstrating only the contrast filled vessels. 3D volumes require a special type of acquisition mode, involving C-arm rotation to acquire images of a region of interest in several projections. The images require reconstruction. There a different types of 3D acquisition modes: 3D DR: 3D volume in native display. 3D DSA: 3D volume with DSA. 3D DR - Large Volume: Native display for large volumes. 3D CARD: A special 3D CARD acquisition. DCT: Dyna CT    PERISTEPPING and PERIVISION are modes of peripheral angiography using a stepping technique to image larger areas, for example from pelvis to feet.  DR STEP: PERISTEPPING PERI: PERIVISION   Roadmap: Roadmap is a special operating mode to help with guidewire and stent placement. During Roadmap, fluoroscopy images are subtracted from one another to display a subtracted image. A mask image is then inverted and superimposed over all subsequent fluoroscopy images. When the mask image contains a contrast filled vessel, the result is an inverted (white) vessel overlaid on the live subtracted fluoroscopic image. There are three variations of Roadmap: Classic Roadmap: The mask is created during fluoroscopy. DSA: Roadmap (CLEARmap): A previously acquired DSA scene is used as the mask. Additional Roadmap: Uses a special technique with acquisition dose for the mask image, for improved image quality.   Overlay Reference: Overlay Reference uses an inverted reference image overlaid on the Live image. Overlay Reference can provide guidance with guidewire and stent placement and help to reduce contrast medium injection by highlighting the vessel on the live image.  Overlay Reference can only be performed if the selected reference image has been acquired with the same imaging parameters as the current live image. Both images must be using the same:  Zoom stage Patient position Same orientation of the detector (landscape or portrait) After applying Overlay reference, you should always confirm that the overlaid image is matched correctly with the live image using anatomical landmarks.   Performing fluoroscopy/acquisition   Fluoroscopy and acquisition are released with the footswitch.   Fluoroscopy is released with the bottom left pedal. Acquisition is released with the top left pedal. ​Acquisition can optionally be released with a handswitch, fluoroscopy cannot be released with the handswitch. To ensure adequate image quality, fluoroscopy needs to be initiated in the region of interest before the first acquisition. This recommendation should be followed whenever the region of interest has a higher variation of density to the previous region of interest.   Radiation Indication: During the examination, as radiation is released, the radiation indicators in the control room and exam room are activated and if configured, an audible sound will be heard. Indicator lights are integrated in the Display Ceiling Suspension (DCS) in the exam room.  You can monitor Radiation dose in the exam room and the control room: Exam room: Radiation dose is indicated in the Info area of the Large Display. Control Room: Radiation dose is indicated on the top right corner of the Examination task card.   Reduce dose and improve image quality The following methods can be used to reduce dose and improve image quality during the examination: Collimation: Reduce dose by reducing the field of view of the radiation and improves image quality by reducing scattered radiation to the detector. Filters:  To achieve a uniform image appearance, Filters can be placed in areas where contrast differences occur as a result of anatomical density differences.  CAREprofile allows for collimator and filter positioning without radiation by demonstrating the collimation and filter positioning as graphical lines on the last image hold (LIH). CAREposition allows you to position the patient without any extra radiation dose to the patient or staff. When activated a rectangular graphic is displayed on the LIH. You can use the cross hair from the graphic to guide you when centering.  Storing and reviewing images Images can be stored as scenes, single images or reference images. Acquisition scenes are automatically stored. Fluoroscopy images must be manually stored. You can store images in the following ways: Store Monitor: Any image of an acquisition scene or fluoroscopic scene or Last image Hold (LIH) can be stored as a Store Monitor image.  Select the key on the Pilot control module in the exam room or Select the Store Monitor icon from the Examination task card on the system console or  Select Store Monitor on the Onscreen menu > General Menu. Reference image: Reference images can be used as guidance during the examination. You can store any image which is currently displayed (acquisition or fluoroscopic image) as a Reference image. To store a reference image: Select the Store Reference image key on the Pilot control module in the exam room or Select the Store Reference image icon from the Examination task card on the system console or Select Store Ref1 or Store Ref2 on the Onscreen menu > General Menu.   Store Fluoro: You can store fluoroscopy scenes of up to 1024 frames. When you select Store Fluoro, the most recent 1024 frames are stored. Select the Onscreen menu > Store Fluoro in either the General or Native/DSA menu or Select the Store Fluoro icon from the Examination task card on the system console or If configured, press on the Store key on the Pilot control module.    Image review can be done in both the control and the exam room.  In the exam room, you use the jog wheel on the Pilot control module to review images.  The functions of the jog wheel in relation to image review are demonstrated in the Info area on the Large Display.    You start the system easily by pressing the power-on button on the Central power control (CPC) in the control room. Keep the power button pressed for approximately 0.5 seconds. All system components are started at the same time, but each component requires a different amount of time to complete start-up. In normal circumstances, you should wait until system start-up is complete and in Full operation mode to start imaging. In time critical situations however, you can start imaging before Full operation mode. The system has different operation modes providing access to functions as they are available: In BYPASS fluoroscopy mode fluoroscopy is available In Backup mode fluoroscopy and acquisitions are available In Full operation all system functions are available ​In BYPASS and Backup mode the software is still initializing and it will not be possible to register a patient, post-process images or store images.   Learn about the operation modes Learn about the operation modes Select the tabs to learn about the operation modesTitleTextBYPASSTab TitleText Exam room In BYPASS mode, system start-up is not complete, but fluoroscopy is available for use in critical clinical or emergency situations. BYPASS appears on the Large Display in the exam room. During BYPASS mode: Fluoroscopy is only visible in the exam room The last image hold (LIH) does not appear on the screen Zoom stage 1 (42 cm) is selected and cannot be changed No images can be stored Post processing is not possible Patient registration is not possible ​Please note: It is possible for the system to be in BYPASS mode in situations other than system start-up, for example, when a system error occurs or when no user is logged in.  Control room During BYPASS the user interface in the control room is not accessible. No images can be stored Post processing is NOT possible Patient registration is NOT possible ​Fluoroscopy is only visible in the exam room Backup modeTab TitleTextExam room In Backup mode it is possible to perform fluoroscopy and acquisitions in time critical situations.  During Backup mode, BYPASS no longer appears on the imaging display. Backup Mode is displayed in the info area on the Large Display. In Backup mode: Post-processing is not possible Patient registration is not possible Exam sets and protocols can only be selected at the touchscreen (it is not possible to select exam sets and protocols at the system console)  ​ Control room In Backup mode the task cards on the monitor in the control room cannot yet be operated. Post-processing is not possible Patient registration is not possible Exam sets and protocols can only be selected at the touchscreen (it is not possible to select exam sets and protocols at the system console) During Backup mode, the images are acquired to a buffer and will be synchronized to the internal memory when start-up is complete.  Full operationTab TitleTextExam room When the system start-up is complete the Welcome screen appears in the exam room. The ARTIS pheno system is now fully functional. An emergency patient is automatically registered, so that you can start an examination immediately after system start-up. If images were acquired during Backup mode, the images were acquired to a buffer. When start-up is complete, the images are synchronized to the internal memory. As this occurs, you will see a message: “Syncing database, ... scene(s) left” in the Info area. If you need to use the acquired images, wait until the synchronization is complete before starting imaging   Control room When system start-up is complete the Home screen is displayed on the display in the control room. The ARTIS pheno system is now fully functional.  ​If images were acquired during Backup mode, the images were acquired to a buffer. When start-up is complete, the images are synchronized to the internal memory. As this occurs, you will see a message: "Syncing database, ... scene(s) left."   If you need to use the acquired images, wait until the synchronization is complete before starting imaging.  If there is a problem with the synchronization, a message appears: “Database not in sync, ... scene(s) left”. In this case stop fluoroscopy and acquisition until the synchronization is complete. If the problem persists, you should restart the system.   There are automatic and manual modes of patient registration. Depending on how your ARTIS system is connected to information services & servers, patient information may be automatically transferred from a connected Sensis or Radiology Information system (RIS) or you many need to manually enter the patient information.   The imaging system automatically registers an emergency patient at start-up and at patient close. This allows you to start an examination immediately in time critical cases. After the examination, the emergency patient data can be modified before final procedure documentation. The exam set and the patient position must be confirmed to complete registration. In addition, depending on the table vendor and table top, you may also be required to select the appropriate Head Holder.   Learn about patient registration Learn about patient registration Slide NumberText BlocksCalloutsAudio ScriptImage File1If your ARTIS pheno is connected to a Radiology Information System (RIS), the system can be configured to automatically update the DICOM worklist at certain time intervals. In some cases, you may need to update the worklist manually. To update the worklist manually: Open the Patient Browser Double click on the scheduler or Select: View > Update Worklist Patients that have not been examined will appear in the Scheduler of the Patient Browser. To start the examination, double click on the patient name: The Patient Registration window opens Add any required data Select the study and the patient position To start the examination select: Exam Please note: To ensure the correct labeling of images the patient position must be checked and entered for every procedure or after a change of the physical patient position on the table. For systems registered as Cardiac only, this may not apply. If your ARTIS pheno is connected to a Radiology Information System (RIS), the system can be configured to automatically update the DICOM work list at certain time intervals. In some cases, you may need to update the work list manually. To update the work list manually, open the Patient Browser, double click on the scheduler or select, view and update Work list. Patients that have not been examined will appear in the scheduler of the patient browser. To start the examination, double click on the patient name. The Patient Registration window opens, add any required data and select the study and the patient position. To start the examination select, exam Please note, to ensure the correct labeling of images, the patient position must be checked and entered for every procedure or after a change of the physical patient position on the table. For systems registered as Cardiac only, this may not apply.2If Sensis is installed, you must register the patient one time only, on the Sensis console. To assure data consistency, the information from the Sensis is transferred to the ARTIS pheno. Select: Patient > Register in the main menu on the Sensis Enter the data (data shown in bold type are mandatory fields) Select the examination type from the study list Click Exam The patient is registered on the Sensis and on the ARTIS pheno.If Sensis is installed, you must register the patient one time only, on the Sensis console. To assure data consistency, the information from the Sensis is transferred to the Artis pheno. Select: Patient, register in the main menu on the Sensis. Enter the data. Data shown in bold type are mandatory fields. Select the examination type from the study list and click Exam. The patient is registered on the Sensis and on the ARTIS pheno.3If there is no connection to a Radiology Information System (RIS), you have to enter the patient data. Patient data can be entered before the examination or pre-registered for examination at a later time. Patient data is entered in the Patient Registration window. To open the Patient Registration window: Press the Patient Registration key on your syngo keyboard or Select: Patient > Register in the Patient Browser or Select: Patient > Register from the system console menu   Hint: Bold fields are mandatory. It will not be possible to complete registration until the mandatory fields are completed. If there is no connection to the RIS, you have to enter the patient data. Patient data can be entered before the examination or pre-registered for examination at a later time. Patient data is entered in the Patient Registration window. To open the Patient Registration window press the patient registration key on your syngo keyboard. Or select patient, register in the patient browser. Or select, patient, register from the System console menu.4When time is critical it may be necessary to start the examination before the patient information is registered. In such cases, the examination can be started with an emergency patient. The system assigns unique emergency information to the patient data. This generated data can be manually altered before closing the patient or sending the patient data to other network nodes.  An emergency patient is automatically registered at system start-up and after patient close. You can alter the patient registration at any time.  To register an Emergency patient: Select: Patient > Emergency from the Patient Browser or Select: Patient > Emergency from the system console menu or Select Emergency from the bottom right corner of the Patient Registration window  Hint: To learn how to alter the patient data, please see the popup titled, Learn how to correct patient data.When time is critical it may be necessary to start the examination before the patient information is registered. In such cases, the examination can be started with an emergency patient. The system assigns unique emergency information to the patient data. These generated data can be manually altered before closing the patient or sending the patient data to other network nodes. An emergency patient is automatically registered at system start-up and after patient close. You can alter the patient registration at any time. To register an Emergency patient select, Patient, emergency from the Patient Browser. Or, select, patient, emergency from the system console menu. Or, select emergency from the bottom right corner of the patient registration window.5If your table and table top offers to make use of a Head Clamp or Head Extension Head Holder, you need to define which head holder is in use before starting the examination. This is needed to enable the collision avoidance computation to include the sphere of the Head Holder into the computation. To select the correct Head Holder: On the system console, Examination task card select: Acquisition > Head Holder If the correct Head Holder is not selected, a default Head Holder will be assigned, with a large safety zone. This will cause a reduction in the speed of system movements in the area of the Head Holder. Change the Head Holder as described to enabled standard movement speed of the C-arm.Hint: If you are not using any Head Holder, it is possible to have the head holder selection permanently disabled in service. You would therefore not need to make this selection. If your table and table top offers to make use of a Head Clamp or Head Extension head holder, you need to define which head holder is in use before starting the examination. This is needed to enable the collision avoidance computation to include the sphere of the head holder into the computation. To select the correct Head Holder, on the system console, select Examination task card , acquisition and then head holder. If the correct Head Holder is not selected, a default head holder will be assigned, with a large safety zone. This will cause a reduction in the speed of system movements in the area of the head holder. Change the head holder as described to enabled standard movement speed of the C-arm. Learn how to correct patient data Learn how to correct patient data Checklist TitleChecklist TypeChecklist ContentOpen the Patient BrowserHTML It is possible to modify emergency patient data and patient data that was manually entered  To correct patient information, open the Patient Browser Select the patient that requires modification. Corrections depend on the selected level in the Patient Browser: Patient - Study - Series - Instance ​Hint: Please note that patient information from the RIS cannot be modified through the ARTIS console. The patient information must be changed on the RIS and/or on the PACS. Select Edit > CorrectHTML   From the menu items in the Patient Browser, select: Edit > Correct   Warning messageHTML Before you can modify patient data, a warning message appears which requires confirmation Select Yes to continue Correct windowHTML     In the Correct window correct the required data in the Patient tab Select the modifierHTML    After modifying the patient data, select your name from the list under Modifier's name Patient data is correctedHTML    After correcting the data, check the entry in the Patient Browser to ensure that the data is correct A pre-programmed Patient Transfer position is part of the System Positions. This can be easily accessed from the touchscreen and it moves the system to an ideal position for transferring the patient to the patient table. For safety reasons radiation and system movements are blocked automatically during patient transfer when using the Patient Transfer position. To clear the way for transfer, slide the rail with the control consoles away from the transfer area and remove all accessories, for example the Head Holder and arm holders. Prior to bringing the patient on the table, ensure that the patient table mattress is secured to the table, for example with Velcro. Park the bed alongside the patient table minimizing gaps. When the patient is positioned on the table, use positioning aids to secure the patient and attach ECG leads if required. Take care with ECG lead placement to ensure that the leads are not in the imaging field of view.    Learn how to move to the patient transfer position Learn how to move to the patient transfer position Checklist TitleChecklist TypeChecklist ContentSelect C-Arm Position on the touchscreenHTML On the touchscreen select the C-Arm Position menu Select the Patient Transfer positionHTML Select: System Positions > Patient Transfer position Message appears: Activate stand movementHTML A message is displayed in the Info area on the Large Display: "Automatic Run: Activate stand movement" Move the system to the positionHTML To activate system movement press and hold Hold to Drive on the touchscreen The system performs the required movements to move to the Patient Transfer position Keep pressing Hold to Drive until the system is in position Please note: It is also possible to activate movement by pressing down on the C-arm joystick on the Pilot control module and deflecting it away from you or if configured, using the hands free pedal on the footswitch. Message: Position reachedHTML When the system movement is completed a message appears in Info area on the Large Display: "Automatic Run: Position Reached" Block movements and block radiation Block movements and block radiation Tab TitleTextBlock movements    Press the Block Movement key on the  Pilot control module (PCM) or Click on the Block Movement icon in the Examination task card on the system console Block radiation    Press the Block Radiation key on the PCM in the exam room or Click on the Block Radiation icon on the Examination task card on the system console Once the patient is positioned on the table and you are ready to start the examination, you can move the system to the working position. The easiest method to move the system to the working position is to select a programmed position on the touchscreen. Alternatively, you can move the system manually using the joysticks on the Pilot control module (PCM) and raising and lowering the table with the Table control module (TCM). There are different types of programmed positions available on the touchscreen: System Positions, Anatomical Positions, Direct Positions and Current Positions.  To access the programmed positions menu, select C-Arm Position on the touchscreen.   Learn about programmed positions Learn about programmed positions Slide NumberText BlocksCalloutsAudio ScriptImage File1System positions are the basic positions.  System positions can be used to move the system to a basic starting position before refining the position for an image view for example, the Head side, Left side and Right side positions. Some system positions are required for non-imaging tasks, such as the Patient Transfer position or the Park Position.   System positions are the basic positions. System positions can be used to move the system to a basic starting position before refining the position for an image view for example, the head side, left side and right side positions. Some system positions are required for non-imaging tasks, such as the Patient Transfer position or the Park Position.2Anatomical Positions create a specific image view, for example a specific LAO/RAO, Cranial/Caudal view. Anatomical Positions are customizable and can be configured to your specific clinical workflow.  Hint: As Anatomical positions create a specific view in relation to the patient, the actual C-arm position may vary depending on the table position and the patient position entered during patient registration. Anatomical positions restore all the image geometry, including zoom, collimator and filter positions.Anatomical Positions create a specific image view, for example a specific LAO, RAO, Cranial, Caudal view. Anatomical positions are customizable and can be configured to your specific clinical workflow. Hint: Because Anatomical positions create a specific view in relation to the patient, the actual C-arm position may vary depending on the table position and the patient position entered during patient registration. Anatomical positions restore all the image geometry, including zoom, collimator and filter postions. 3Direct Positions are your most frequently used positions which can be accessed easily during the case. During the examination when a particular view demonstrates the anatomy of interest, you can store it as a Direct Position so that the position can be easily recalled later.  There are three Direct Positions and they can be accessed anytime during the examination by swiping from right to left on the touchscreen.  To store a position as a Direct Position, press Save as Direct Position on the touchscreen. The position will be stored in the next available space, position 1, 2 or 3. If all of the spaces are filled, select the position that you would like to overwrite.  Direct Positions are your most frequently used positions which can be accessed easily during the case. During the examination when a particular view demonstrates the anatomy of interest, you can store it as a Direct position so that the position can be easily recalled later. There are three Direct Positions and they can be accessed anytime during the examination by swiping from right to left on the touchscreen. To store a position as a Direct position, press Save as direct position on the touchscreen. The position will be stored in the next available space, position one, two or three. If all of the spaces are filled, select the position that you would like to overwrite.4To recreate an image view demonstrated in a reference or 3D image, select the Current Positions menu.  Please note: It is only possible to move to the targeted positions if no collision has been detected.    To recreate an image view demonstrated in a reference or 3D image, select the Current Positions menu. Please note that it is only possible to move to the targeted positions if no collision has been detected. Learn how to move to programmed positions Learn how to move to programmed positions Slide NumberText BlocksCalloutsAudio ScriptImage File1To move to a pre-programmed system position, select C-Arm Position from the touchscreen and select the applicable target position: System Positions Anatomical Positions Direct Positions Current Positions Hint: The selection will stay to the last selected choice. To change the selection, just tab on the name of the current selection or on the arrow next to it. To move to a pre-programmed system position, select C-arm position from the touchscreen and select the applicable target position; system positions, anatomical positions, direct positions or current positions Hint: The selection will stay to the last selected choice. To change the selection, just tab on the name of the current selection or on the arrow next to it. 2After you have selected a position, a message appears in the Info area on the Large Display, prompting you to activate movement. On the touchscreen a message appears: Hold to Drive Press Hold to Drive on the touchscreen ​The system will move to the programmed position while Hold to Drive is pressed To stop the movement, simply release Hold to Drive   Hint: It is also possible to activate movement by pressing down on the C-arm joystick and deflecting it away from you or if configured, using the hands free pedal on the footswitch.The movement of the C-arm is faster when the joystick is deflected.After you have selected a position, a message appears in the Info area on the Large Display, prompting you to activate movement, 'Automatic run: Activate stand movement.' On the touchscreen a message appears, Hold to Drive. Press Hold to Drive on the touchscreen. ​The system will move to the programmed position while Hold to Drive is pressed. To stop the movement, simply release Hold to Drive. Hint: It is also possible to activate movement by pressing down on the C-arm joystick and deflecting it away from you or if configured, using the hands free pedal on the foot switch. The movement of the C-arm is faster when the joystick is deflected.3When moving to the programmed position the system will move as many components simultaneously as possible in order to reach the position in the most efficient path.  If you are using the joystick to activate movement, the speed of the movement depends on the degree of joystick deflection. That means that maximum speed occurs with maximum joystick deflection. If table rotation is required as part of the system position, a message will appear in the system messages area on the Large Display to rotate the table. Movement will stop if the method of engagement is released or if any collision is detected by the system.  Hint: If the movement is not activated for a period of time, the selection of the system movement will be cancelled and the system will return to its original state. You will need to select the position again to invoke further movements.When moving to the programmed position the system will move as many components simultaneously as possible in order to reach the position in the most efficient path. If you are using the joystick to activate movement, the speed of the movement depends on the degree of joystick deflection. That means that maximum speed occurs with maximum joystick deflection. If table rotation is required as part of the system position, a message will appear in the system messages area on the large display to rotate the table. Movement will stop if the method of engagement is is released or if any collision is detected by the system. Hint: If the movement is not activated for a period of time, the selection of the system movement will be cancelled and the system will return to its original state. You will need to select the position again to invoke further movements.4When the system is fully in position, a message appears in the Info area on the Large Display: "Automatic run: Position reached" It is important that you do not stop the movement until this message is displayed. This ensures that the system is in the correct position and where applicable, the collimator and filter positions are applied correctly.When the system is fully in position, a message appears in the info area on the large display: Automatic run: Position reached. It is important that you do not stop the movement until this message is displayed. This ensures that the system is in the correct position and where applicable, the collimator and filter positions are applied correctly. Learn how to store anatomical positions Learn how to store anatomical positions Slide NumberText BlocksCalloutsAudio ScriptImage File1You can store your own Anatomical Positions at any time. Move the system to the desired position and include the following settings: Image zoom Collimator and filter positions    You can store your own Anatomical Positions at any time. Move the system to the desired position and include the following settings; Image zoom, Collimator and filter positions.2To store an Anatomical Position: Open the C-Arm Position menu Select the menu Anatomical Positions At the top right of the menu select the + symbol The list of positions appears Select a free memory position The Save icon appears in the top right corner Press the Save icon Take care when storing a position. If you select a memory position that already has a position saved, the new position will overwrite the previously stored position.   Hint: Programmed positions can be renamed,  protected from deletion or from being overwritten in the Organize Stored Positions configuration on the system console. CalloutsSelect the + symbolSelect the positionSelect the Save iconTo store an Anatomical Position, open the C-Arm Positions menu. Select the menu Anatomical Positions. At the top right of the menu select the plus symbol. The list of positions appears. Select a free memory position. The Save icon appears in the top right corner. Press the Save icon. Take care when storing a position. If you select a memory position that already has a position saved, the new position will overwrite the previously stored position. Hint: Programmed positions can be protected from deletion or from being overwritten in the Organize Stored Positions configuration on the system console. 3You can organize the programmed positions on the system console. Select: Options > Configuration and double click on the icon: Organize Stored Positions. When open, you will see a list of the stored positions. Next to the position, a symbol may be present to indicate: A default position that is pre-defined by Siemens Healthineers and which cannot be edited or deleted A protected position which cannot be deleted or overwritten You can edit the stored positions in the following ways: Change the order of a position using the up and down arrows Rename positions (if the position is not protected) Protect a position from deletion Copy the position to another list Delete unprotected positions You can organize the programmed positions on the system console. ​Select, options, configuration and double click on the icon organize Stored positions. When open, you will see a list of the stored positions. Next to the position, a symbol may be present to indicate, a default position that is pre-defined by Siemens Healthineers and which cannot be edited or deleted. A protected position which cannot be deleted or overwritten. You can edit the stored positions in the following ways; change the order of a position using the up and down arrows. Rename positions (if the position is not protected). Protect a position from deletion. Copy the position to another list. Delete unprotected positions. Acquisition, fluoroscopy and roadmap protocols are arranged in exam sets that are adapted for the specific body region and examination type.  An exam set is comprised of: A number of acquisition protocols (with the possibility of one alternative acquisition protocol) Three fluoroscopy protocols known collectively as a fluoro triplet Possibly three assigned roadmap protocols The selected exam set and protocol are shown in the Info area on the Large Display, on the Examination task card of the system console and on the touchscreen.   Exam sets and protocols in the control room Exam sets and protocols in the control room Base ImageHotspotsText BlocksImage FileExam set The exam set contains the fluoroscopy/roadmap and acquisition protocols for the body part and region  Acquisition protocol The settings below relate to the acquisition protocolFluoroscopy protocol The settings below relate to the fluoroscopy protocol Exam sets and protocols in the exam room Exam sets and protocols in the exam room Base ImageHotspotsText BlocksImage FileExam set The exam set contains the fluoroscopy/roadmap and acquisition protocols for the body part and region  Acquisition protocolFluoroscopy protocol Fluoroscopy and acquisition are released with the footswitch. Acquisition can optionally be released with a handswitch.  Fluoroscopy is released with the bottom left pedal. Acquisition is released with the top left pedal. To ensure adequate image quality, fluoroscopy needs to be initiated in the region of interest before the first acquisition. This recommendation should be followed whenever the region of interest has a higher variation of density to the previous region of interest. It may also be necessary to perform fluoroscopy during certain acquisition modes, the system will provide you with guidance in these situations. To provide you with fast access to a special acquisition protocol, it is possible to have one of the pedals of the footswitch assigned as an Alternative acquisition pedal. This could be used for low dose protocols, single shot acquisitions or CLEARstent acquisitions.   Learn about the handswitch Learn about the handswitch The handswitch has two buttons: The Acquisition button on the top of the handswitch for releasing acquisitions   The Multi-functional button on the side of the handswitch The Multifunctional button has different functions depending on the selected protocol. In Variable Frame Rate (VFR) protocols it is used to switch from one phase to the next In PERIVISION or PERISTEPPING it is used to start stepping In 3D protocols it is used to start the next phase Please note: It is not possible to release fluoroscopy using the handswitch.   Collimation reduces the radiation field to the area of interest which not only reduces radiation dose, but also improves image quality by reducing the amount of scatter radiation to the detector. To achieve a uniform image appearance, filters can be placed in areas where contrast differences occur as a result of anatomical density differences. CAREprofile allows for collimator and filter positioning without radiation and should be utilized whenever possible. When activated, a graphical box for the collimator blades and a graphical outline of the filters appears on the last image hold (LIH). You can use the graphical lines to move the collimator blades and filters into position without releasing radiation. CAREposition is a feature that allows you to position the patient without any extra radiation dose to the patient or personnel. CAREposition is activated during C-arm and table movements when fluoroscopy is not active. When activated a rectangular graphic is displayed on the LIH. You can use the cross hair from the graphic to guide you when centering.      Learn more about Wedge filters Learn more about Wedge filters Filters can help improve image quality by compensating for anatomical density differences, resulting in a more uniform image appearance. There are two types of filters available:  Wedge filters (two filters, left and right) Finger filter (one filter) The thickness of the Wedge filter varies across the filter in a uniform manner, from thin to thick. When applied, the filter varies the intensity of the x-ray beam, compensating for the variation in anatomical density. Wedge filters can be used clinically in Cardio-angiography and DSA.  The Finger filter is rectangular in shape and is more uniform than Wedge filters. The Finger filter can be used to compensate for anatomical density differences when imaging the aortic arch or during DSA examinations of the legs.   You use the top two joysticks on the Collimator control module to apply filters on images. To change between the Wedge and Finger filter, select the toggle key in the middle of the two filters.    To document the examination, for in-procedure or post-procedure review or to use images for clinical guidance, you must first store images. Images can be stored as scenes, single images or reference images. Acquisition scenes are automatically stored on ARTIS systems. To save space on the Hard drive, fluoroscopy images are not automatically stored; you will need to manually store either a single fluoroscopy image or a fluoroscopy scene. To store a single frame of an acquisition scene or fluoroscopy last image hold (LIH) you use the Store Monitor function. Fluoroscopy and Roadmap scenes can be stored with Store Fluoro.  Any image from a fluoroscopy/Roadmap scene (LIH) or an image from an acquisition scene can be stored as a Reference image. When a reference image has been stored, it is displayed on the Reference one segment on the Large Display.  Image review can be accessed from the control or exam room. You review images in the exam room using the jog wheel on the Pilot Control Module (PCM) and in the PostProc task card on the system console in the control room.    Learn about storing images Learn about storing images Slide NumberText BlocksCalloutsAudio ScriptImage File1Any image of an acquisition scene, fluorosocopy scene or Last image Hold (LIH) can be stored as a Store Monitor image.  You can store a Store monitor image during x-ray release or after x-ray release has been stopped. When storing a Store Monitor during fluoroscopy/Roadmap, the stored image will be available after x-ray is stopped. You can store up to 512 Store Monitor images per study.  A Store Monitor image can be stored in either the exam or the control room:  Select the key on the Pilot control module in the exam room or Select the Store Monitor icon from the Examination task card on the system console or  Select Store Monitor on the Onscreen menu  Hint: The Onscreen menu is configurable. Please check with your Siemens Healthineers service representative the configuration of menu items on your system.Any image of an acquisition scene, fluorosocopy scene or last image Hold (LIH) can be stored as a Store Monitor image. You can store a Store monitor image during x-ray release or after x-ray release has been stopped. When storing a Store Monitor during fluoroscopy or Roadmap, the stored image will be available after x-ray is stopped. You can store up to 512 Store Monitor images per study. A Store Monitor image can be stored in either the exam or the control room. Select the key on the Pilot control module in the exam room to store a store monitor image or select the Store Monitor icon from the Examination task card on the system console, or select store monitor on the onscreen menu from the general menu.2You can store any image which is currently displayed (acquisition or fluoroscopy image) as a Reference image. Reference images are stored in a Directory and are displayed on the reference segment on the Large Display. You can also access the Reference directory from the system console.  For each study up to 64 reference images can be stored. A reference image can be stored in either the exam or the control room: Select the Store Reference image key on the Pilot control module in the exam room or Select the Store Reference image icon from the Examination task card on the system console or  Select Store Ref1 or Store Ref2 on the Onscreen menu Hint: If configured, two reference images can be stored and displayed on the respective segments.You can store any image which is currently displayed (acquisition or fluoroscopy image) as a Reference image. Reference images are stored in a Directory and are displayed on the reference segment on the Large Display. You can also access the Reference directory from the system console. For each study up to 64 reference images can be stored. A reference image can be stored in either the exam or the control room. Select the Store Reference image key on the Pilot control module in the exam room or select the Store Reference image icon from the Examination task card on the system console, or select store ref one or store ref two on the onscreen menu in the general Menu.3With Store Fluoro you can store fluoroscopy and Roadmap scenes of up to 1024 frames. When you select Store Fluoro, the most recent 1024 frames are stored. In fluoroscopy, depending on the examination requirement, you may use different pulse rates. This means, that the time of the stored fluoro loop will vary because the limit is based on number of frames not on the time of flurosocopy.  A fluoroscopy scene can be stored in either the exam or the control room: Select the Onscreen menu > Store Fluoro or Select the Store Fluoro icon from the Examination task card on the system console  Hint: Depending on your configuration, it may also be possible to Store Fluoro using the Store key on the Pilot Control Module. Please check with your Siemens Healthineers service representative. With Store Fluoro you can store fluoroscopy and Roadmap scenes of up to 1024 frames. When you select Store Fluoro, the most recent 1024 frames are stored. In fluoroscopy, depending on the examination requirement, you may use different pulse rates. This means, that the time of the stored fluoro loop will vary because the limit is based on number of frames not on the time of flurosocopy. A fluoroscopy scene can be stored in either the exam or the control room. Select the Onscreen menu, Store Fluoro in either the General or Native DSA menu or select the Store Fluoro icon from the Examination task card on the system console. 4Image review can be done in both the control and the exam room.  In the exam room, you use the jog wheel on the Pilot control module to review images.  The functions of the jog wheel in relation to image review are demonstrated in the Info area on the Large Display.  There are dedicated keys on the Pilot control module to open the Reference and Scene directories to review previously stored reference images, scenes or store monitor images. You can review images in the control room in the PostProc task card on the system console.   Hint: You can also access the reference and scene directories from the Onscreen menu. CalloutsOpen reference image directoryThe jog wheel operates image review functionsOpen scene directoryImage review can be done in both the control and the exam room. In the exam room, you use the jog wheel on the Pilot control module to review images. The functions of the jog wheel in relation to image review are demonstrated in the Info area on the Large Display. There are dedicated keys on the Pilot control module to open the reference and scene directories to review previously stored reference images, scenes or store monitor images. You can review images in the control room in the Post processing task card on the system console. Learn about image review in the exam room Learn about image review in the exam room   Roadmap is a special operating mode to support guidewire and stent placement. In preparation of Roadmap, fluoroscopy images are subtracted from one another to create a subtracted mask image. This mask image is inverted and superimposed over all subsequent fluoroscopy images. When the mask image contains a contrast filled vessel, the result is an inverted (white) vessel overlaid on the live subtracted fluoroscopic image. There are three variations of Roadmap: Classic Roadmap: The mask is created during fluoroscopy DSA Roadmap (CLEARmap): A previously acquired DSA scene is used as the mask Additional Roadmap: Uses a special technique with acquisition dose for the mask image, for improved image quality Please note: During Roadmap, the Live segment displays the Roadmap image and the Reference one segment displays either the Reference image or the Live native image. The setting can be selected in the Examination task card on the system console.   Learn about Classic and Additional Roadmap Learn about Classic and Additional Roadmap Slide NumberText BlocksCalloutsAudio ScriptImage File1In classic Roadmap all imaging is done with fluoroscopy, including the creation of the mask image.  To start Roadmap, select Roadmap from either the touchscreen in the exam room or from the system console in the control room. From the touchscreen select: RDMP and Overlay> Roadmap From the system console select: Examination task card > Roadmap icon   In classic Roadmap all imaging is done with fluoroscopy, including the creation of the mask image. To start Roadmap, select Roadmap from either the touchscreen in the exam room or from the system console in the control room. From the touchscreen select roadmap and overlay and Roadmap. From the system console select the Examination task card and then the Roadmap icon. 2After you have selected Roadmap and you are ready to start imaging, press on the fluoroscopy pedal on the footswitch.  In Phase one of Roadmap, the images are displayed native.   Phase one has two stages: Phase one (a) and Phase one (b). During Phase one (a), the dose regulation is occurring During Phase one (b), the images are being averaged to create a mask for subtraction Keep your foot pressed on the fluoroscopy pedal, the transition to Phase two will occur automatically. After you have selected Roadmap and you are ready to start imaging, press on the fluoroscopy pedal on the footswitch. In Phase one of Roadmap, the images are displayed native. Phase one has two stages; Phase one A and Phase one B. During Phase one A, the dose regulation is occurring. During Phase one B, the images are being averaged to create a mask for subtraction. Keep your foot pressed on the fluoroscopy pedal, the transition to Phase two will occur automatically. 3When Phase two is entered the images are displayed subtracted. At the beginning of Phase two an injection symbol appears in the Info area on the Large Display. When you see the injection symbol, start injecting contrast.  Keep your foot pressed on the fluoroscopy pedal until the vessels of interest have been filled with contrast. When the vessels have been filled, you can release the fluoroscopy foot pedal.  After x-ray stop in this phase, the Live segment shows a LIH. Maximum opacification is effective in this phase.   What is Maximum Opacification? Usually the contrast medium does not fill the vessels uniformly, rather the contrast medium bolus “travels” through the vessels. The maximum opacification function combines the images of the fill phase to one image to demonstrate the path taken by the contrast medium.When Phase two is entered the images are displayed subtracted. At the beginning of Phase two an injection symbol appears in the Info area on the Large Display. When you see the injection symbol, start injecting contrast. Keep your foot pressed on the fluoroscopy pedal until the vessels of interest have been filled with contrast. When the vessels have been filled, you can release the fluoroscopy foot pedal. After X-ray stop in this phase, the Live segment shows a last image hold. Maximum opacification is effective in this phase. 4You start Phase three of Roadmap by releasing fluoroscopy. During this phase the images appear subtracted and the mask image is the maximum opacification image of the contrast filled vessel. The vessel appears inverted (white) and overlaid on the live subtracted image. Roadmap will stay in Phase three with every new release of fluoroscopy.  To exit Roadmap, select Roadmap on the touchscreen or select the Roadmap icon in the Examination tab on the system console. You start Phase three of Roadmap by releasing fluoroscopy. During this phase the images appear subtracted and the mask image is the maximum opacification image of the contrast filled vessel. The vessel appears inverted (white) and overlaid on the live subtracted image. Roadmap will stay in Phase three with every new release of fluoroscopy. To exit Roadmap, select Roadmap on the touchscreen or select the Roadmap icon in the Examination tab on the system console. 5Additional Roadmap is a special Roadmap technique used for higher image quality than fluoroscopy. Acquisition dose is used for the vessel map creation (Phase one and Phase two) and fluoroscopy dose is used in Phase three and Phase four. The fluoroscopy pedal is used for all phases. The workflow for additional Roadmap is basically the same as with Classic Roadmap. The main difference in the Additional Roadmap workflow, is that you need a specific exam set selected when Roadmap is activated. Certain exam sets have a DSA protocol configured as an alternative acquisition in Roadmap mode. The DSA protocol selected as the alternative acquisition will be used for the mask creation.  Please check with your Siemens Healthineers education representative which exam set to select for Additional Roadmap.   Additional Roadmap is a special Roadmap technique used for higher image quality than fluoroscopy. Acquisition dose is used for the vessel map creation (Phase one and Phase two) and fluoroscopy dose is used in Phase three and Phase four. The fluoroscopy pedal is used for all phases. The workflow for additional Roadmap is basically the same as with Classic Roadmap. The main difference in the Additional Roadmap workflow, is that you need a specific exam set selected when Roadmap is activated. Certain exam sets have a DSA protocol configured as an alternative acquisition in Roadmap mode. The DSA protocol selected as the alternative acquisition will be used for the mask creation. Please check with your Siemens Healthineers education representative which exam set to select for Additional Roadmap. Learn about DSA roadmap Learn about DSA roadmap Slide NumberText BlocksCalloutsAudio ScriptImage File1In DSA Roadmap either a previously acquired DSA reference image or the automatically generated Maximum opacification image of a previously acquired DSA scene can be used as the mask. All other images are created with fluoroscopy.  First you need to create a DSA scene. If the vessels are clearly demonstrated and you would like to use the image for Roadmap, save a reference image using the key on the Pilot control module.  If you are using a DSA protocol that has Maximum Opacification configured, the DSA reference image will be automatically generated after activation of DSA Roadmap. Please check with your Siemens Healthineers education representative which protocol can be used to utilize this function.  In DSA Roadmap either a previously acquired DSA reference image or the automatically generated Maximum opacification image of a previously acquired DSA scene can be used as the mask. All other images are created with fluoroscopy. First you need to create a DSA scene. If the vessels are clearly demonstrated and you would like to use the image for Roadmap, save a reference image using the key on the Pilot control module. Hint: If you are using a DSA protocol that has Maximum Opacification configured, the DSA reference image will be automatically generated after activation of DSA Roadmap. Please check with your Siemens Healthineers education representative which protocol can be used to utilize this function. 2Once your DSA image is stored as a reference image, you can start Roadmap. On the touchscreen select: RDMP and Overlay > Roadmap > DSA RDMP Ref1 or DSA RDMP Ref2 (depending on the reference segment on which your DSA image is stored). Please note: In the following circumstances, DSA Roadmap will not be possible: If the system has moved since the reference image was taken, this includes C-arm and table movement If there are changes to image zoom  Hint: You can also select DSA Roadmap from the control room. On the system console select: Examination task card > DSA or DSA 2 iconOnce your DSA image is stored as a reference image, you can start Roadmap. On the touchscreen select: Roadmap and Overlay, Roadmap, DSA Roadmap, Ref one or DSA Roadmap Ref two (depending on the reference segment on which your DSA image is stored). Please note that in the following circumstances, DSA Roadmap will not be possible: If the system has moved since the reference image was taken, this includes C-arm and table movement. If there are changes to image zoom. 3Before starting Roadmap check the following:  No system movements have occurred since the original acquisition was acquired The patient has not moved since the reference image was stored There is a DSA subtracted reference image on either the Reference one or Reference two segment You have selected the DSA Roadmap protocol that matches the reference segment on which the reference image is stored When you are ready to start Roadmap, press the fluoroscopy pedal on the footswitch. Roadmap will start in Phase one and the images will appear in native display (without subtraction).  During phase one, the system is regulating the dose and then creating a mask image. Keep the foot pedal on the footswitch pressed until the subtracted image is displayed. Before starting Roadmap check the following: No system movements have occurred since the original acquisition was acquired. The patient has not moved since the reference image was stored. There is a DSA subtracted reference image on either the Reference one or Reference two segment. You have selected the DSA Roadmap protocol that matches the reference segment on which the reference image is stored. When you are ready to start Roadmap, press the fluoroscopy pedal on the footswitch. Roadmap will start in Phase one and the images will appear in native display (without subtraction). During phase one, the system is regulating the dose and then creating a mask image. Keep the foot pedal on the footswitch pressed until the subtracted image is displayed.4When you see the subtracted image keep the fluoroscopy foot pedal on the footswitch pressed. Because the mask was already created from the DSA reference image, you do not need to inject any contrast media. With the next release of the fluoroscopy foot pedal, Roadmap automatically switches to Phase three and the images appear with the inverted DSA image overlaid on the live subtracted image. You can release and activate the fluoroscopy footswitch as required. Roadmap will remain active until you disable Roadmap on the touchscreen. When you see the subtracted image keep the fluoroscopy foot pedal on the footswitch pressed. Because the mask was already created from the DSA reference image, you do not need to inject any contrast media. With the next release of the fluoroscopy foot pedal, Roadmap automatically switches to Phase three and the images appear with the inverted DSA image overlayed on the live subtracted image. You can release and activate the fluoroscopy footswitch as required. Roadmap will remain active until you disable Roadmap on the touchscreen. Learn about operation in Roadmap mode Learn about operation in Roadmap mode Slide NumberText BlocksCalloutsAudio ScriptImage File1Due to patient movement, subtracted images may not coincide exactly. If this occurs, the images can be adjusted during Roadmap (when no x-ray is being released). You can adjust the images using manual and automatic methods of Pixelshift.  Onscreen menu: DSA Menu >  Auto Pixelshift or Manual Pixelshift You use the jog wheel on the Pilot control module to adjust the images.  On the system console in the control room: PostProc task card > DSA sub task card, click on the Pixel shift icon Hint: To return to the original settings, prior to when pixel shift was applied, on the Onscreen menu select: DSA Menu > Pixelshift Home. Due to patient movement, subtracted images may not coincide exactly. If this occurs, the images can be adjusted during roadmap (when no x-ray is being released). You can adjust the images using manual and automatic methods of pixel shift. On the onscreen menu select the DSA Menu, auto pixel shift or manual pixel shift. You use the jog wheel on the Pilot control module to adjust the images. In the control room on the post processing task card select the DSA sub task card and click on the Pixel shift icon.2In the exam room it is possible to change either the Anatomical Background or the vessel or catheter contrast. The  available selection depends on the setting on the system console: Acquisition > Set Anatomical Background/ Set Vessel/Catheter contrast When Set Vessel/Catheter Contrast is selected: VC/CC Contrast can be selected on the touchscreen When Set Anatomical Background is selected: Anatomical Background can be select on the touchscreen and on the Onscreen menu  In the exam room it is possible to change either the Anatomical Background or the vessel or catheter contrast. The available selection depends on the setting on the system console; acquisition, set anatomical background, set vessel or catheter contrast. When set vessel catheter contrast is selected; vessel contrast, catheter contrast can be selected on the touchscreen. When set anatomical background is selected; anatomical background can be select on the touchscreen and on the onscreen menu.3In a subtracted scene, the anatomical background is normally not visible. In some cases however, it can be beneficial to visualize the anatomical background, particularly when using anatomical landmarks.  The anatomical background can be set between 0% and 100%. At 0% the display is subtracted. At 100% the images appear in native display To adjust the anatomical background:  Onscreen menu: DSA Menu > Anatomical Background Touchscreen:  RDMP &Overlay > Roadmap > Anatomical Background You use the jog wheel on the Pilot control module to adjust the anatomical background.​ On the system console in the control room: PostProc task card > DSA sub task card, click on the adjust Anatomical Background icon Hint: Anatomical Background will not be available for selection on the touchscreen or on the Onscreen menu if VC/CC is selected.In a subtracted scene, the anatomical background is normally not visible. In some cases however, it can be beneficial to visualize the anatomical background, particularly when using anatomical landmarks. The anatomical background can be set between zero percent and one hundred percent. At zero percent, the display is subtracted. At one hundred percent, the images appear in native display. To adjust the anatomical background; on the onscreen menu select the DSA Menu, anatomical background. On the touchscreen, select roadmap and overlay, roadmap and anatomical background. You use the jog wheel on the pilot control module to adjust the anatomical background. In the control room on the post processing task card, DSA sub task card click on the adjust anatomical background icon. 4During Roadmap you may need to visualize the catheter or the vessel in greater detail. The initial values for vessel contrast and catheter contrast are defined in the Roadmap protocol. The vessel and catheter contrast can be adjusted during Roadmap. Touchscreen: RDMP &Overlay > Roadmap > VC/CC Contrast You use the jog wheel on the Pilot control module to adjust the vessel and catheter contrast.  On the system console, PostProc task card, in the main menu select: Image > Change Vessel / Catheter Contrast Use the up and down arrows to adjust the values.Hint: VC/CC will not be available for selection on the touchscreen if Anatomical Background is selected.During roadmap you may need to visualize the catheter or the vessel in greater detail. The initial values for vessel contrast and catheter contrast are defined in the roadmap protocol. The vessel and catheter contrast can be adjusted during roadmap. On the touchscreen select, roadmap and overlay, roadmap vessel contrast and catheter contrast. You use the jog wheel on the Pilot control module to adjust the vessel and catheter contrast. On the system console, on the post processing task card, in the main menu select, image, change vessel, catheter contrast. Use the up and down arrows to adjust the values.5When performing Roadmap, it is possible for motion artifact to occur. If this occurs, you can reset Roadmap and create a new mask image using the Reset Roadmap function.  Touchscreen: RDMP &Overlay > Roadmap > Reset Roadmap On the system console in the control room: Examination task card > Roadmap Dialog, click on the Reset Roadmap icon It is possible that your footswitch is configured with a Reset Roadmap foot pedal. Please confirm with your Siemens Healthineers service representative.When performing Roadmap, it is possible for motion artifact to occur. If this occurs, you can reset Roadmap and create a new Mask image using the Reset Roadmap function. On the system console in the control room, select the Examination task card, Roadmap Dialog and click on the reset roadmap icon. Hint: It is possible that your footswitch is configured with a Reset roadmap foot pedal. Please confirm with your Siemens Healthineers service representative.6During certain procedures such as, embolization procedures involving coiling, many embolization agents may be deployed, making visualization of guidewires difficult.  For such cases, Show Progress can be activated during Roadmap. When activated, the last image hold (LIH) is used to replace the mask image. As a result, the previously deployed embolization agents are subtracted, resulting in a subtracted Roadmap view.   Touchscreen: RDMP & Overlay > Roadmap > Show Progress On the system console in the control room: Examination task card > Roadmap Dialog, click on the Show Progress icon. During certain procedures such as, embolization procedures involving coiling, many embolization agents may be deployed, making visualization of guide wires difficult. For such cases, Show progress can be activated during roadmap. When activated, the last image hold (LIH) is used to replace the mask image. As a result, the previously deployed embolization agents are subtracted, resulting in a subtracted Roadmap view. On the touchscreen, select roadmap and overlay, roadmap, show Progress. On the system console in the control room click on the show progress icon in the roadmap dialog. 7During Roadmap, you may need to visualize an area of interest in greater detail. It is possible to 'Zoom and pan' in Roadmap mode. Onscreen menu: DSA menu > Zoom by Factor 2 Touchscreen: RDMP &Overlay > Roadmap > Zoom by Factor 2 This function should only be utilized as required and it is not intended for prolonged use.  If you determine that you require detail enhancement for a longer period of time, use other functions, for example, enlarge the zoom stage and re-acquire the mask, or choose a different layout with a larger live segment on the Large Display.  During Roadmap, you may need to visualize an area of interest in greater detail. It is possible to 'Zoom and pan' in Roadmap mode. You can activate 'Zoom and pan' from the Onscreen menu, select, the DSA menu, Zoom by factor two. This function should only be utilized as required and it is not intended for prolonged use. If you determine that you require detail enhancement for a longer period of time, use other functions, for example, enlarge the zoom stage and re-acquire the mask, or choose a different layout with a larger live segment on the large display. 8During Roadmap two Roadmap mask images may be stored for two system positions, for example, an LAO and an RAO C-arm position. You can move back and forth between the two positions, performing Roadmap at each position without reacquiring a Roadmap mask.  Select Roadmap and perform Roadmap in one system position Move the C-arm to another C-arm position and perform Roadmap After Roadmap is performed in the second system position Previous Mask is available on the touchscreen in the Roadmap menu.   To move the system to the previous Roadmap position, select Previous Mask on the touchscreen Select: Drive to Position Press Hold to Drive on the touchscreen The system moves to the position for the previous Roadmap mask.Hint: Previous Roadmap is only accessible on the touchscreen when Roadmap has been activated in two system positions.During Roadmap two Roadmap mask images may be stored for two system positions, for example, an LAO and an RAO C-arm position. You can move back and forth between the two positions, performing Roadmap at each position without reacquiring a Roadmap mask. Select Roadmap and perform Roadmap in one system position. Move the C-arm to another C-arm position and perform Roadmap. After Roadmap is performed in the second system position previous mask is available on the touchscreen in the roadmap menu. To move the system to the previous Roadmap position, select previous mask on the touchscreen. Select, drive to position. Press Hold to Drive on the touchscreen. The system moves to the position for the previous Roadmap mask When in the working position, it is good practice to ensure that the organ of interest is in the isocenter. The isocenter is the center of rotation of the C-arm. By placing the organ of interest in the isocenter, you ensure that the organ remains within the field of view during C-arm angulations, limiting the need to change the table height throughout the examination. Once the isocenter has been defined, you can store the isocenter on the touchscreen of the Pilot control module (PCM). If the table height is then changed, the distance away from the isocenter is indicated in the Info area on the Large Display. You can easily move the table back to isocenter using the touchscreen. When adjusting the working height, to maintain the distance of the table to the detector (and the x-ray tube) you can couple the C-arm and table movements using the key on the Pilot control module. Please note: Positioning the organ of interest in the isocenter is a requirement for 3D imaging.     Learn more about the isocenter Learn more about the isocenter Slide NumberText BlocksCalloutsAudio ScriptImage File1When setting the isocenter, you align the region of interest in the frontal plane and you adjust the working height so that the region of interest is centrally located between the image receptor and the focal spot of the tube. By defining the isocenter you save valuable time during the examination, because the region of interest remains in the center of the field of view as the C-arm is angled. When the isocenter is not set, in some projections the region of interest may not always be centrally positioned in the field of view and you may need to adjust the patient position.  Hint: The isocenter height is the distance from the organ of interest to the tabletop (without the mattress) and it is displayed on the Large Display.When setting the isocenter, you align the region of interest in the frontal plane and you adjust the working height so that the region of interest is centrally located between the image receptor and the focal spot of the tube. By defining the isocenter you save valuable time during the examination, because the region of interest remains in the center of the field of view as the C-arm is angled. When the isocenter is not set, in some projections the region of interest may not always be centrally positioned in the field of view and you may need to adjust the patient position. 2The most accurate way to set the isocenter is to perform fluoroscopy in the frontal and lateral planes to confirm that the region of interest is centrally located on the image. The basic workflow of setting the isocenter is as follows: Place the C-arm in the frontal position Position the region of interest in the center of the field of view Perform fluoroscopy briefly to check the positioning Rotate the C-arm to the lateral position Perform fluoroscopy to check the position Raise or lower the table so that the region of interest is in the center of the field of view Set the isocenter on the touchscreen: Table > Define as ROI  The most accurate way to set the isocenter is to perform fluoroscopy in the frontal and lateral planes to confirm that the region of interest is centrally located on the image. The basic workflow of setting the isocenter is as follows: Place the C-arm in the frontal position. Position the region of interest in the center of the field of view. Perform fluoroscopy briefly to check the positioning. Rotate the C-arm to the lateral position. Perform fluoroscopy to check the position. Raise or lower the table so that the region of interest is in the center of the field of view. Set the isocenter on the touchscreen, table, define as Region of interest.3After the isocenter has been set, if you change the position of the table, it is easy to return the table height to the isocenter height. To return the table back to the isocenter: Select Table > Height Press the Move table to isocenter icon on the touchscreen (The Move table to isocenter icon appears after selecting Height on the touchscreen) This only applies if the isocenter has been set.After the isocenter has been set, if you change the position of the table, it is easy to return the table height to the isocenter height. To return the table back to the isocenter, select table, height. Press the Move table to isocenter icon on the touchscreen. (The Move table to isocenter icon appears after selecting Height on the touchscreen). Hint: This only applies if the isocenter has been set. Learn how to couple C-arm and table movements Learn how to couple C-arm and table movements Tab TitleTextSelect the couple C-arm and table key   On the Pilot control module, select the key to couple C-arm and table movement When the LED is blue the C-arm and table are coupled Please note: It is also possible to couple the table and C-arm from the touchscreen: Table > Couple C-Arm Perform table movements Once the table and C-arm are coupled, if you now raise or lower the table, the C-arm movement will be synchronized You select the exam set during patient registration. During the examination you may need to select a different exam set, fluoroscopy or acquisition protocol or adjust the parameters for the protocol. You can make adjustments to the settings from both the control room and exam room. In the control room, you make adjustments in the Examination task card on the system console. In the exam room adjustments are made on the touchscreen.  It is possible to change the fluoroscopy/roadmap protocol, the acquisition protocol and the following parameters: Fluoroscopy pulse rate, Acquisition frame rate, Measuring field and Scene length In addition, you can make adjustments to the zoom stage and the fluoroscopy dose settings using the keys on the Pilot control module.  Please note: It is not possible to change the acquisition frame rate for Variable Frame Rate (VFR) protocols.   Learn how to adjust the zoom and fluoroscopy dose Learn how to adjust the zoom and fluoroscopy dose   Learn how to change parameters on the touchscreen Learn how to change parameters on the touchscreen Instructions:Flash File:/content/generator/Course_90018821/sim_Change_Parameters_touchscreen_2/sim_Change_Parameters_touchscreen_2.htmHTML5 File:/content/generator/Course_90018821/sim_Change_Parameters_touchscreen_2/index.htmlPDF File: Learn how to change parameters in the control room Learn how to change parameters in the control room Instructions:Flash File:/content/generator/Course_90018821/sim_change_parameters_system_console/sim_change_parameters_system_console.htmHTML5 File:/content/generator/Course_90018821/sim_change_parameters_system_console/index.htmlPDF File:   After start-up is complete the Home screen is displayed in the control room.                                                          The Home screen provides direct access to related tasks for starting the examination: • Patient registration • Searching for patients • Importing patient data Additionally, you will find access to the online help, configuration panel and shutting down the system. Learn more about the Home screen Learn more about the Home screen Base ImageHotspotsText BlocksImage FileSchedule Patient: Opens the Patient Browser schedulerContinue Procedure: Opens the Examination task card Please note: Continue Procedure appears only after the examination task has been previously opened or after start-up when images have been acquired during backup mode. Emergency Patient: Opens the emergency patient registration windowRegister Patient: Opens the patient registration windowBrowse Data: Opens the Patient Browser Local DatabaseImport Data: Opens the window to search for patient dataSearch PACS: Opens the window to search the PACS for dataShutdown: Opens the dialog to shutdown or restart the systemHelp: Opens the online helpSettings: Opens the configuration menu   After system start-up the Welcome screen appears in the exam room. The patient name, registered patient position and exam set are displayed. When no patient has been registered and directly after system start-up an emergency patient is registered so that you can quickly start an examination.   During the examination, as x-ray is released, the radiation indicators in the control room and exam room are activated and if configured, an audible sound will be heard. Indicator lights are integrated in the Display Ceiling Suspension (DCS).  You can monitor the patient radiation dose from the displays in both the control room and the exam room. In the exam room dose information is located in the Info area on the Large Display. You can find the dose information in the control room on the system console at the top right corner of the Examination task card. The fluoroscopy timer is activated for each fluoroscopy event and will show the elapsed time of uninterrupted fluoroscopy. An audible sound will alarm and a message box will appear when a configured time of fluoroscopy has elapsed. The configured time will depend upon the regulations in your country. For safety reasons, radiation will be blocked after 10 uninterrupted minutes of fluoroscopy. Please note: At the end of the examination a dose report is available in the Patient Browser.   An alternative operation mode to help with guidance is Overlay Reference (Overlay Ref). Overlay Ref uses an inverted reference image overlaid on the Live image. Overlay Ref can provide guidance with guidewire and stent placement and help to reduce contrast medium injection by highlighting the vessel on the live image.  Overlay Ref can only be performed if the selected reference image has been acquired with the same geometric conditions as the current live image. Both images must be using the same:  Zoom stage Patient position Same orientation of the detector (landscape or portrait) After applying Overlay Ref, you should always confirm that the overlaid image is matched correctly with the live image using anatomical landmarks. During Overlay Ref, the Live segment displays the Overlay image and the Reference 1 segment displays either the Reference image or the Live native image. The setting can be selected in the Examination task card on the system console. Please note: You cannot use Roadmap and Overlay Ref at the same time. If you select Roadmap, Overlay Reference will automatically close.   Learn how to activate Overlay Reference Learn how to activate Overlay Reference Tab TitleTextOverlay Ref: Touchscreen                                   On the touchscreen select: RDMP and Overlay Ref > Overlay Ref > Overlay Ref1 or Overlay Ref2 (depending on which reference segment the image of interest is located)  Overlay Ref: Control room     From the system console select: Examination task card > Overlay Reference one or two icon (depending on which reference segment the image of interest is located) A wide range of examinations are possible on the ARTIS pheno. Images can therefore be acquired in different acquisition modes. Depending on your system options, images may be acquired in native or digitally subtracted display (DSA), in 2D or 3D. Some examinations require dedicated acquisition modes, for example, when imaging the lower extremities you may select another special type of acquisition mode, Peristepping or Perivision.  It is important that you are familiar with the different acquisition modes and the associated terminology. The popup titled Learn about acquisition modes will introduce you to some of the common acquisition modes on the ARTIS.  Please note: The acquisition modes available on your system depend on your system configuration.      Learn about acquisition modes Learn about acquisition modes Slide NumberText BlocksCalloutsAudio ScriptImage File1Digital radiography (DR) is a technique where images are acquired digitally without subtraction. The images may be acquired as a series or as a single frame, known as a single shot.  During image review the acquisition mode displayed for digital radiography images is DR.  Digital radiography (DR) is a technique where images are acquired digitally without subtraction. The images may be acquired as a series or as a single frame, known as a single shot. During image review the acquisition mode displayed for digital radiography images is DR.2The images acquired in cases with an interventional Cardiology focus are 2D, native (without subtraction) and are acquired as a series acquisition (multiple frames).  During image review the acquisition mode displayed for 2D cardio-angiography images is CARD.  The images acquired in cases with an interventional Cardiology focus are 2D, native (without subtraction) and are acquired as a series acquisition (multiple frames). During image review the acquisition mode displayed for 2D cardio-angiography images is CARD.3Digital subtraction angiography (DSA) is a special mode of acquisition to demonstrate vessels. In DSA, images are acquired: Without contrast medium - the mask images With contrast medium - the fill images A subtraction is performed between the mask and the fill images to result in a 2D subtracted image, demonstrating only the contrast filled vessels. During image review the acquisition mode displayed for digital subtraction angiography images is DSA. This mode has the added benefit that the entire sequence can also be displayed in native display (without subtraction).   Digital subtraction angiography (DSA) is a special mode of acquisition to demonstrate vessels. In DSA, images are acquired, without contrast medium, the mask images and with contrast medium, the fill images. A subtraction is performed between the mask and the fill images to result in a 2D subtracted image, demonstrating only the contrast filled vessels. During image review the acquisition mode displayed for digital subtraction radiography images is DSA. Hint: This mode has the added benefit that the entire sequence can also be displayed in native display (without subtraction).43D visualizations require a special type of acquisition mode, involving a C-arm rotation to acquire images in several projections. The images are reconstructed in application software to provide volume data. As a result, a number of computed 2D slices are loaded into the 4D viewer. As these images are CT-like, similar functions for visualization and editing are available, comparable to CT image processing. 3D examinations require special protocols and the system must be licensed and calibrated to perform the acquisitions.     For CT-like imaging of soft tissues, images can be acquired in 3D known as DynaCT.  There are different types of 3D acquisition modes and the acquisition mode displayed depends on the images: 3D DR: 3D volume in native display 3D DSA: 3D Volume with DSA 3D DR - Large Volume: Native display for large volumes 3D CARD: A 3D cardiac acquisition 3D visualizations require a special type of acquisition mode, involving a C-arm rotation to acquire images in several projections. The images are reconstructed in application software to provide volume data. As a result, a number of computed 2D slices are loaded into the 4D viewer. As these images are CT-like, similar functions for visualization and editing are available, comparable to CT image processing. 3D examinations require special protocols and the system must be licensed and calibrated to perform the acquisitions. There a different types of 3D acquisition modes: 3D DR relates to 3D volumes in native display. 3D DSA relates to 3D volumes with DSA. 3D DR, Large Volume relates to large volumes in native display. 3D CARD is a 3D cardiac acquisition. For CT-like imaging of soft tissues images can be acquired in 3D known as DynaCT. The acquisition mode displayed depends on the images; 3D CARD, 3D DSA, 3D DR and Large Volume is 3D DR - Large volume.5PERISTEPPING and PERIVISION are modes for peripheral angiography using a stepping technique to image larger areas, typically down the legs. The images can be acquired in native display (DR) as in PERISTEPPING or in subtracted display (DSA) as with PERIVISION.  The acquisition modes displayed depends on the acquisition type: DR STEP: PERISTEPPING PERI: PERIVISION Peristepping and Perivision are modes for peripheral angiography using a stepping technique to image larger areas, typically down the legs. The images can be acquired in native display (DR) as in Peristepping or in subtracted display (DSA) as with Perivision. The acquisition modes displayed depends on the acquisition type. DR Step Peristepping or Peri Perivision. Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. Please contact your local Siemens sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2017

  • artis
  • pheno
  • artispheno
  • pheno operation
  • atris
  • peno
  • feno
  • angio
  • angiography
  • interverntional